Healthcare Provider Details

I. General information

NPI: 1124945704
Provider Name (Legal Business Name): JOSIAH DANIEL BEDUNNAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

2602 FRANKLIN ST
LINCOLN NE
68502-3038
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-1111
  • Fax:
Mailing address:
  • Phone: 308-325-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117058
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: